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Relative atherosclerotic plaque volume by CT coronary angiography trumps conventional stenosis assessment for identifying flow-limiting lesions

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Abstract

The new methods for diagnosing the ischemia with coronary computed tomographic angiography (CTA) as a noninvasive test have been investigated. To compare the relative plaque volume to quantitative CTA and quantitative coronary angiography (QCA) for detecting flow-limiting coronary artery stenoses. We studied 49 patients with 55 intermediate lesions (30–69% diameter stenosis) who underwent CTA, coronary angiography (CAG), and FFR. CTA and QCA measures included lesion length, percent diameter stenosis (%DS), minimal lumen diameter (MLD), target main vessel percent plaque volume (%PV), lesion %PV, target main vessel percent lumen volume (%LV), and lesion %LV. FFR ≤0.80 was considered diagnostic of a flow-limiting lesion. The area under the receiver-operating characteristic curve (AUC) was used to determine the accuracy of detecting flow-limiting lesions. We also investigated the AUC of discrimination of flow-limiting lesion according to calcium score. Eighteen of 55 lesions (32.7%) had an FFR ≤0.80. Only vessel %PV differentiated between lesions with and without flow obstruction (67.6 vs. 62.7%, p = 0.018). The AUC for vessel %PV was greatest (0.76; 95% CI 0.61–0.87). The AUC for the discrimination of the flow-limiting lesions according to low calcium score (≤400) improved to 0.82 (95% CI 0.57–0.94). In intermediate coronary artery stenoses, vessel %PV is more accurate than conventional stenosis assessment for detecting flow-limiting lesions. In low calcium score, vessel %PV is more useful for diagnosis of ischemic heart disease compared with conventional quantitative measures.

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Acknowledgements

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiology, Mitsui Memorial Hospital, 1 Kandaizumi-cho, Chiyoda-ku, Tokyo, Japan

    Nahoko Kato, Shuzou Tanimoto, Jiro Aoki, Mika Watanabe, Yu Horiuchi, Koichi Furui, Kazuhiro Hara & Kengo Tanabe

  2. Division of Diabetes Mitsui Memorial Hospital, 1 Kandaizumi-cho Chiyoda-ku, Tokyo, Japan

    Satoru Kishi

  3. Division of Cardiology, Johns Hopkins Hospital and School of Medicine, Blalock 524, 600N Wolfe Street, Baltimore, MD, 21287, USA

    Armin Arbab-Zadeh & Joao A. C. Lima

  4. The Ottawa Hospital Research Institute and Department of Radiology, The University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    Frank J. Rybicki

  5. Division of Diagnostic Radiology Mitsui Memorial Hospital, 1 Kandaizumi-cho Chiyoda-ku, Tokyo, Japan

    Kenji Ibukuro

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  1. Nahoko Kato
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  2. Satoru Kishi
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  3. Armin Arbab-Zadeh
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  5. Shuzou Tanimoto
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  7. Mika Watanabe
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  8. Yu Horiuchi
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  9. Koichi Furui
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  10. Kazuhiro Hara
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  11. Kenji Ibukuro
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  12. Joao A. C. Lima
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  13. Kengo Tanabe
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Correspondence to Satoru Kishi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kato, N., Kishi, S., Arbab-Zadeh, A. et al. Relative atherosclerotic plaque volume by CT coronary angiography trumps conventional stenosis assessment for identifying flow-limiting lesions. Int J Cardiovasc Imaging 33, 1847–1855 (2017). https://doi.org/10.1007/s10554-017-1186-z

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  • DOI: https://doi.org/10.1007/s10554-017-1186-z

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